In this comprehensive radio series, with 14 programs, Dr Alyssa Vass is joined by Yolŋu (Yolngu) consultants to explain the complex diseases of Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD) – including how it occurs, prevention, management and ongoing treatment. An essential resource for any Yolngu at risk of, or with a diagnosis of, RF or RHD.

The programs are also available in CD format.

Rheumatic Fever and Heart Disease - 1 of 14 - Introduction

Introduction to the speakers and the topic of Rheumatic Heart Disease and Rheumatic Fever. (Length 2:07)

Rheumatic Fever and Heart Disease - 2 of 14 - Intro to RF and RHD

Explains the differences between Rheumatic Heart Disease and Rheumatic Fever, but also explores the relationship between the two. Rheumatic Heart Disease occurs when someone has had Rheumatic fever too many times and as a result has too much damage to their heart causing heart disease. Information on the history of both diseases is provided. 6:55

Rheumatic Fever and Heart Disease - 3 of 14 - How does RF happen?

Explaining how Strep A bacteria, a nasty bacteria, can enter our bodies through a skin sore. The reaction of white blood cells is explained in their attempt to rid the body of this bacteria. This is described as a big fight between the white blood cells and the bacteria. This fight has a number of different effects on the body: fever, aching joints and sometimes damage to the valves (or doors) inside the heart. 6:17

Rheumatic Fever and Heart Disease - 4 of 14 - How do we stop RF?

How do we stop RF? One antibiotic called penicillin or LA Bicillin. This kills the bad germ Strep A. But if you get RF again and again you can get damage to your heart and get RHD. If you get RF once and get LA bilcillin once, how do you get it again? Anytime you get another skin sore or sore throat, Strep A can be living there. Even if they get penicillin once, if they get another sore, they can then get RF again. So don‘t just accept ’sores‘ on our skin, get them treated and cover them up. This is part of a bigger story.6:10

Rheumatic Fever and Heart Disease - 5 of 14 - Bicillin and Penicillin

Why do some kids get that injection called Bicillin or penicillin? To stop them getting RF again and again. The penicillin medicine is always in their body and kills any strep A so that our white blood cells won‘t need to start a big fight. Don‘t miss any injections because they could get RF again. Each time they get RF they can get more damage to their heart valves and end up with the other sickness RHD. The valves are important for moving our blood around the right way. 4:53

When the valves are damaged what happens? Inside our heart are four rooms and four doors. Our blood comes into our heart and through the doors. The doors keep the blood going one way only, the right way. When the doors get damaged, they can‘t shut properly and some blood goes back the wrong way. This makes our heart work harder because some of our blood is going back the wrong way through the damaged door. Remember what causes the damage, the bad bacteria called Strep A, and where does strep A come from? Our sores. When we listen with the stethoscope we can hear the doors of our heart shutting: Dup Dup Dup Dup. We can hear the sound of the blood going back the wrong way through damaged doors: Dup shhh Dup shhh. Doors are called valves. 7:31

Rheumatic Fever and Heart Disease - 7 of 14 – How do we stop valve damage?

How do we stop the doors from getting more damaged? The only way we know is having the injection every three or four weeks. This stops RF and then we won‘t get RHD. Having the penicillin injection every month is the only way we can protect the valves. People who have had RF need the injection for many, many years and only the heart specialist can tell you when to stop having it. Get the injection every month so the strep A won‘t go into your body. If you are not in your usual community and your injection is due, go to a health clinic anywhere and ask for your injection. Never miss your injection. 6:41

Rheumatic Fever and Heart Disease - 8 of 14 - Heart Operations

Why do some children have a heart operation in a big city? To put a new door in their heart. But even if they have this operation, they still need the injection to protect the other doors, remember there are four doors. Don‘t think that if you have had the operation you are now back to normal. Even if you have the operation, you can be well and live long and do the things you want to do. Even our prime minister of Australia has had this operation. But you still need the penicillin injection to stop the Strep A bacteria from going into your body.5:21

When you have RHD and your heart is weak, you will be continually getting the penicillin. But you will also most likely be having other medicines as well. These medicines will help your heart to work to send your blood to your body. We don‘t want people to be getting RHD so that‘s why it is important to get the penicillin injections. If you have RHD, don‘t think that you are ok and the sickness has disappeared. Your valves are damaged and you need to have medicines to help your heart. The first sickness is RF and the second sickness, RHD, is a very serious one. They are two different sicknesses. Only the doctor can tell you when to stop your injections. 6:28

Rheumatic Fever and Heart Disease - 10 of 14 - How do valves get damaged? The deeper story

How do the valves actually get damaged? It‘s a complex story. Remember the Strep A and the WBC‘s? When we look at this Strep A through the microscope, we can see tiny dots or marks on their skin. Our white blood cells notice these marks and it tells them that the bacteria are Strep A. Some children have marks that look like this on their heart valves, like a birth mark. They don‘t hurt the child, they are just born with them. When Strep A if found by the WBCs, they attack them. When the Strep A and the WBCs are fighting, the WBCs notice the marks on the valves. They think that the valves are more strep A and they attack them by mistake. When Strep A repeatedly goes into a childs body, the WBCs recognise the dots on the valves and make the mistake and attack the valves. There are three entities in this story: the bad bacteria Strep A, the White Blood cells who make a mistake and the heart valves. The dots on the valves are carried through family lines. 15:18

Where does strep A live? In sores on our skin or in a sore throat. It doesn‘t live on healthy skin because our natural skin oils kill them. Strep A can travel from person to person by our hands etc. The strep A can stick onto our hands even though we can‘t see them there. It is like they get a free ride. And if we then touch our skin and our skin has a tiny hole in it, then the Strep A can go in and make a new home there and start to reproduce there. So strep A goes from a person with sores to another person without sores. The other way is if we have strep A living in our sore throat and we cough or spit, then the strep A can come out through the air and go to another person, or be in our spit. So by coughing or spitting.7:03

How can I stop Strep A from going into my body or going from person to person? There are many ways. Washing our skin regularly. And if we hug or touch a person with sores, then we can wash our hands to stop the strep A from sticking onto our hands. If we have any skin sores, treat with traditional or clinic medicine and cover it with a bandage. Then no one can touch the sore and get the strep A onto their hands. Even if the sores are small. Also treat scabies because scabies burrow in and make holes in our skin. Scabies make us itchy and we also make holes in our skin when we scratch. And then Strep A can enter through the holes. 8:44

Rheumatic Fever and Heart Disease - 13 of 14 – The RHD Register

In the NT doctors have made a list of all the people who have either of these two sicknesses RF or RHD so they don‘t forget anyone‘s injection and look after them well. This is called the Rheumatic Heart Disease Register and you can have your name on this list if you agree. In countries where there is a list there is less RHD because children don‘t get forgotten when they have these diseases. When your name is on the list this helps to stop RHD. And when you are travelling and your injection is due, tell the clinic or hospital there so you can get your injection. 6:30

Rheumatic Fever and Heart Disease - 14 of 14 – At the dentist

When we go to the dentist for teeth problems he asks lots and lots of questions. Why? When we have a sore tooth or an abscess in our gums this is caused by different bacteria, not Strep A. Sometimes those bacteria can go into our blood and on to our heart. And if we have damage to our valves from RF then the different bacteria can do more damage to our valves. So the dentist asks us about RF and RHD to find out if we have had these diseases. If we have, then he can give us different antibiotic medicine to kill the bacteria in our teeth or plaque before he gives us an injection to numb our gums. This is another way to protect our heart valves. So don‘t think that the dentist is being impolite by asking lots of questions. Tell him if you have had RF or RHD. 6:14